Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

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1 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres Item type Authors Citation Publisher Report Dillon, Maurice; Peacock, Theresa; Gartland, Nuala; Crowe Mullins, Esther; O Reilly, Áine Dillon, M., Peacock, T., Crowe Mullins, E., Gartland, N., O Reilly, Á. (2016) Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres. Dublin, Ireland. HSE Health Service Executive (HSE) Downloaded 3-May :11:14 Link to item Find this and similar works at -

2 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres HSE National Occupational Therapy Managers Group in Mental Health Division, 2016 Maurice Dillon, Theresa Peacock, Nuala Gartland, Esther Crowe Mullins, Áine O Reilly

3 Contents Acknowledgements 2 Foreword 3 Background 4 Literature Review 5 Survey 8 Guidelines 14 References 16 Appendix 1 18 Acknowledgements The authors wish to thank all the occupational therapists who assisted in producing this document by completing the survey. We thank the national HSE mental health division occupational therapist group for the feedback on earlier drafts and support of the subgroup project. We welcome the foreword from our HSE Mental Health Division National Director, Ms Anne O Connor, and acknowledge the support from the Mental Health Division. A note on the authorship Authored on behalf of the HSE Occupational Therapy Managers in the Mental Health Division subgroup by Maurice Dillon, Theresa Peacock, Esther Crowe Mullins, Nuala Gartland and Áine O Reilly. This document can be cited as follows: Dillon, M., Peacock, T., Crowe Mullins, E., Gartland, N., O Reilly, Á. (2016) Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres. Dublin, Ireland. HSE 2 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

4 Foreword I am pleased to introduce the HSE Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres. The development of these standards and guidelines marks another step forward in ensuring that occupational therapy services to residents within adult inpatient acute mental health approved centres meets the highest standards. The process of developing these guidelines emanates from a focus on promoting a service user-centred and recovery-oriented service. The survey responses highlight the range and breadth of interventions and reflect the good practice in the use of occupation for both assessment and intervention within approved centres. The provision of occupational therapy within approved centres is complex and therefore inconsistencies in approach to service delivery arise. These guidelines make it easier for those responsible for those delivering and quality assuring services to work from a common foundation. The aim is that these guidelines will promote continuous improvement of the quality of services provided to residents of approved centres and add to the body of knowledge around occupational therapy service provision in Ireland. I want to acknowledge all of those who participated in surveys and providing feedback for their time. Particular thanks to the HSE Mental Health Occupational Therapist Managers Group for a guidance document that will underpin best practice in occupational therapy interventions into the future. Anne O Connor National Director for Mental Health Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 3

5 Background The role of occupational therapy in acute adult inpatient mental health approved centres was discussed at a number of meetings of the HSE Occupational Therapy Managers in Mental Health Division Group. There was an identified gap of a reference document for Irish practice standards for occupational therapists in acute adult inpatient mental health approved centres. A subgroup was established to develop a national reference document and to establish standards and guidelines for Irish occupational therapy services within these approved centres. The subgroup agreed to the process of initially surveying current occupational therapy practice within adult mental health approved centres. Secondly, the group would complete a literature review to review best practice based on current policy and research. Thirdly, the subgroup would establish guidelines for occupational therapy services in Irish adult acute mental health approved centres. This document is the result of the survey, literature review and guidelines development. We wish to note the limitations of this document as referring only to adult acute inpatient mental health approved centres. Further consideration may need to be given to development of a reference document for occupational therapy practice standards in specialist approved centres, such as for psychiatry for later life, intellectual disability, continuing care, and forensic mental health, as well as child and adolescent services. 4 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

6 Literature review Occupational therapy in acute mental health The number of inpatients in Irish psychiatric units has decreased significantly over the past 50 years from 18,044 in 1966 to 2,401 in 2013 (HRB, 2013). Vision for Change recommends that there should be 50 acute inpatient beds per catchment area inclusive of adult mental health, mental health services for older people and intellectual disability (Department of Health, 2006). This would leave an equivalent of 763 beds nationally based on the current Irish population meaning only those individuals who are very unwell will be admitted to hospital (Faedo, Normand, 2013). The expansion of community mental health services is leading to a shift away from the inpatient setting as the focal point of care. This is reflected in the occupational therapy literature in mental health whereby the practice of occupational therapy in acute mental health is currently overshadowed by a focus on community based care p483 (Lloyd, Williams, 2010). A review of five years of mental health literature in the American Journal of Occupational Therapy revealed 31 published research articles related to the practice area of mental health (Gutman, Greenfield, 2014). Of these 31, only one study by Odes et al. (2011) dealt specifically with an acute mental health setting. In the UK, Lal (2010) wonders if the pendulum shift towards community based services runs the risk of blindsiding the needs and issues of inpatient mental health care (p 493). There is agreement that the acute inpatient setting remains an important component of holistic treatment in mental health services and the occupational therapy role in inpatient mental health requires development to remain current. (Garcia et al., 2005, Lloyd, Williams, 2010). While the number of inpatient beds in acute approved units has decreased there is evidence of shorter admission times and an increased percentage of involuntary admissions (HRB, 2013). It has also meant a change in the population profile of acute inpatient units whereby clients are frequently very unwell and there is also evidence of an increase in clients with a dual diagnosis of mental health and substance misuse issues (Sims, 2014). The need for occupational therapy to adapt to these changes was highlighted by Melton, Forsyth and Metherall 2008 who outline how they used the Model of Human Occupation (MOHO) to guide a redesign of their acute inpatient occupational therapy service and how they used it to develop a care pathway to support occupation-focused practice. The care pathway enabled the occupational therapist to set appropriate goals, grade the level of support needed from the therapist and develop a plan with the client to address core areas of self care, leisure and productivity. The work by Garnham et al. (2010) builds further on the concept of occupational therapy developing care pathways to support use of evidence-based tools and promote occupational therapy s specific contribution to mental health practice. They outline and explain 24 possible areas of occupational therapy intervention, many of which are suitable for clients in acute phases of mental illness. For example, building self efficacy to engage in activity, rapport building Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 5

7 and graded engagement and the re-motivational process are three examples of the type of intervention suitable for someone in the early stages of engagement with an occupational therapist in an inpatient setting. In Britain the College of Occupational Therapy also recommends that occupational therapists in mental health build pathways of care to highlight what service users can expect of their intervention (COT, 2006). Lloyd, Williams (2010) reviewed the literature on the practice of occupational therapy within an inpatient setting and found a broad range of practices described. They identified four core elements of occupational therapy practice in acute mental health. These being individual assessment, individual treatment, therapeutic groups and discharge planning. They recommend that occupational therapy practice in acute mental health should place a renewed focus on these four core elements in order to develop a more consistent role for occupational therapy in this setting and to build a body of research. In relation to staffing, the discussion paper Defining a good mental health service by the Sainsbury centre for mental health recommends one senior occupational therapist and one staff grade occupational therapist for a 20 bed acute inpatient mental health unit (Boardman, Parsonage, 2005). Individual work Duffy and Nolan (2005) describe two ways in which occupational therapists in acute settings use individual work. Firstly, to engage service users with the group programme and secondly, to address specific therapy goals identified by the service user. In a study of service users views of occupational therapy in acute mental health, one of the outcomes reported was a desire by participants to have more individual sessions with the occupational therapist. Lal (2010) also wondered in her recent discussion piece whether occupational therapy should focus more on individual assessment and treatment to address individuals needs but recognises that this may increase the gap around group-based services that clients receive while they are in hospital. Sims (2014) describes the importance of exploring relapse prevention and to support people in their discharge in order to prevent readmission. She also advocates for a blanket referral system in acute hospitals to provide the occupational therapist with the advantage of making their own decisions as to whom is appropriate to prioritise for individual occupational therapy. Group work Group work remains a core part of occupational therapy practice in acute mental health. The type, style and number of groups offered will be influenced by factors such as environment, resources, therapists skills and service user needs (Cole, 2008). In a UK survey of occupational therapists working in inpatient mental health settings, 100% of participants (n=63) were involved in facilitating group work (Duffy and Nolan, 2005). In another UK study researching service users views of occupational therapy in mental health settings, group interventions which had an occupational focus and were considered meaningful were deemed most beneficial. Specifically cookery, sports 6 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

8 and gym groups were identified as being most useful by service users (Lim et al., 2007). There is a growing body of research on how creative activities contribute to the recovery process by providing experiences of flow, fostering hope, and allowing people rebuild their identities (Parkinson, 2014). In a large scale study in an Australian inpatient setting (n=403) attendance at a creative activity had a positive correlation to improved mental health (Caddy et al., 2012, in Parkinson, 2014). Physical activity has been shown to have a positive relationship with mental health (Galper et al., 2006). Exercise has been demonstrated to contribute to improvements in mood, concentration, social interaction, meaningful use of time, purposeful activity and empowerment (Parkinson, 2014). Other research has underscored the benefits of having structured group activities in relieving boredom, reducing conflict with staff and reducing self-harm (Binnema, 2004, Bowers et al., 2008). Lim states that occupational therapy groups in an inpatient mental health setting should have a protocol that explains the therapeutic aims as well as the process. They should also be flexible to accommodate those that are acutely unwell (Lim, 2014). There are however almost no guidelines as to what amount of therapeutic or social/recreational groups should be available in an acute inpatient setting (Lal, 2010). Lal identifies a need for guidelines to be developed for group programmes in acute mental health and that occupational therapy can take a leadership role in developing these in collaborations with service users, families and other disciplines. In the Irish context there are no guidelines for services on the appropriate staffing, skill mix, care pathways or therapeutic interventions that should be available in an inpatient setting. Regulation 16 of the Mental Health Act 2001 (Approved Centres) Regulations 2006 states that each resident should have access to an appropriate range of therapeutic services and programmes in accordance with his or her individual care plan and that programmes and services provided shall be directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of a resident (MHC, 2006). These are very general guidelines and open to wide interpretation as to what is an appropriate range of services. The Mental Health Commission has recently published a Judgement Support Framework, which gives some guidance for approved centres in terms of what evidence the Mental Health Commission is looking for in relation to the Mental Health Act Regulations. Guidance for compliance for the 34 Regulations is given under four headings: Defined Processes in Place, Training, Monitoring and Evidence of Implementation (Mental Health Commission, 2015). In relation to Regulation 15, Individual Care Plans, the Mental Health Commission seeks that a comprehensive assessment of the resident forms the basis of their individual care plan, that the assessment has multidisciplinary input and that evidence-based assessments are used where possible. In relation to Regulation 16, Therapeutic Services and Programmes, the Mental Health Commission seeks evidence that there is dedicated facilities for the provision of both individual and group therapy input. It requires that the therapeutic services and programmes meet the assessed needs of the individual and are documented in the care plan. Therapeutic records should provide an account of the participation, engagement and outcomes for the individual resident. (Mental Health Commission, 2015) Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 7

9 Survey of occupational therapy services within adult acute inpatient approved centres in Ireland Development of survey of occupational therapy within adult acute inpatient approved centres A draft survey was developed by the subgroup to establish current occupational therapy practice within adult mental health approved centres. It was sent on 3/10/14 to the national managers group for feedback. Changes were made based on feedback and further discussion at the next meeting of subgroup on 30/10/14. The survey was sent on 31/10/14 to the National Occupational Therapy Managers group (See appendix). A reminder was sent on 17/11/14. Twenty surveys were returned prior to the deadline of 5/12/14. Size of approved centres The average number of beds per approved centre within the survey was 35 beds. The range was 16 to 52. Vision for change proposes that 50 beds are provided for each mental health catchment area of 300,000 population (DOH, 2006). This can be located in a single unit or across two units in a catchment area but should be based in a general hospital. This survey would reflect a trend that most services are opting to develop one acute unit of between 40 and 50 beds depending on their population size. Occupational therapy staffing The range of occupational therapists employed within the surveyed approved centres was 0 to 3. Eighteen out of 20 centres had at least one dedicated occupational therapist employed for the approved centre. Fourteen of these positions were singled handed. There were 7.5 senior occupational therapy staff and 11.9 staff grade employed within the 20 units surveyed. The vast majority of services have an occupational therapist employed within the approved centre. It is notable though that most occupational therapist posts were single handed, particularly as staff grade positions outnumbered senior posts. 8 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

10 Occupational therapy assistants There were three occupational therapy assistants employed in approved centres which took part in this survey. The role and the scope of the occupational therapy assistant and the arrangements for supervision and governance in the approved centre deserves further consideration. Other allied health professions For the 20 approved centres, there were: 5.3 social workers (1 held also an assertive outreach role) 4.7 psychologists (1 held also an assertive outreach role) 1 speech and language therapist (Held community caseload also) 1 dietician (Held community caseload too) This survey showed a significant shortage of other allied health professions working within approved centres. It is internationally recognised that modern mental health care should be provided by a multidisciplinary team (Lloyd, Williams, 2010). Limited access to health professionals presents a barrier to effective multidisciplinary working within approved centres. Nationally there are no recommendations on the staffing of approved centres in Ireland. However, Regulation 16 of the Mental Health Act 2001 (Approved Centres) Regulations 2006 states that residents of an approved centre should have access to an appropriate range of therapeutic services (MHC, 2006). Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 9

11 In-reach from community mental health occupational therapy Twelve of the 20 sites surveyed indicated there was in-reach from community mental health occupational therapists. This varied from attendance at ward rounds to a regular weekly group. One service with no inpatient occupational therapist had significant input into the therapeutic group programme from community mental health occupational therapists. Referral procedure Twelve centres indicated referrals were a mixture of verbal and written referrals. Five centres accepted written referrals only. One centre indicated blanket referral to occupational therapy. One centre indicated verbal referrals only. Referral for groups Twelve approved centres indicated at least partial blanket referral to group programmes. Five centres indicated they didn t have separate referral criteria for group programmes and access to programmes was through a written/verbal referral to the occupational therapist: It appears that the majority of occupational therapy services require a written/verbal referral for individual work but that most centres accepted clients to at least some groups without a referral. Number of groups The range of groups facilitated by occupational therapists in each approved centre was 0-20 groups per week. On average each approved centre had 10 groups facilitated by occupational therapy staff per week. The ratio of occupational therapy staff to number of groups facilitated was one WTE to 7.8 groups. The number of groups facilitated per week by one staff member varied significantly. The percentage of open groups was 60%. There was significant diversity in the amount of group work provided by occupational therapists in approved centres although an average of one staff member to almost eight groups would appear high considering the size of the individual units. Other issues highlighted included a high percentage of lone working and time constraints due to other responsibilities including individual work, care planning and administration that are part of the role. 10 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

12 Number of groups co-facilitated with other professions Twelve out of 20 replied that there was co-facilitation of groups between occupational therapy and other professions. Of the 12 that replied yes, 10 had at least one weekly group co-facilitated with another profession, while two had sessional groups with another profession involved. Both of the sessional groups were co-facilitated with psychology. Of the 10 sites who had regular co-facilitated groups, 50% indicated more than one group a week was co-facilitated with another discipline. Social work was the most likely profession to co-facilitate a group in an approved centre with an occupational therapist: Social work = n = 7 Nursing = n = 4 Art teacher/therapist = n = 4 Psychology = n = 2 Yoga teacher = n = 1 Given that this survey indicates that many occupational therapists work alone in approved centres and that there is a shortage of other disciplines, this finding that co-facilitation is a feature of many approved centres is to be welcomed. Therapeutic programme Eight sites had nursing staff dedicated to contributing to a therapeutic programme. Seven sites had regular input from community mental health teams. Of the seven sites, five had psychology input to the therapeutic programme, four had social work, one had community mental health nursing, and one had psychiatry. Fourteen sites had regular sessional input from teachers/instructors. This breaks down as follows: 13 had an art teacher/art therapist providing sessional input. 2 had a music teacher 2 had a yoga teacher Others = 4 From the above responses it appears that the majority of approved centres have some sessional input predominantly from art teachers/art therapists. One-third of approved centres also had input from members of their sector community mental health teams particularly psychology and social work. Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 11

13 Care planning meeting Eighteen out of 20 surveys reported that occupational therapists attend care planning meetings. Average number of meetings per week is five and occupational therapists on average attended 3.6. Three approved centres indicated they shared attendance at these meetings with occupational therapists from sector teams. A number of responses indicated that the occupational therapy staff strive to attend as many meetings as they could but due to clinical commitments prioritised which meetings to attend on a weekly basis. The responses from the survey indicate a very high level of attendance of occupational therapists at care planning meetings which reflects the requirements under the Mental Health Act 2001 (Approved Centres) Regulations 2006 for the development of a multidisciplinary care plan in unison with each resident. Documentation Sixteen responses indicated that occupational therapy notes were part of a continuous multidisciplinary note in one file. Two responses indicated a separate section for occupational therapy within the main file. Two responses indicated that occupational therapy documentation was held separately. 12 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

14 List of occupational therapy interventions/activities/programmes A total of 34 separate items were named in this response. The top ranked were: Intervention/Activity/Programme Number of Responses Relaxation/Mindfulness 13 Cooking/Baking/Kitchen Skills 13 Art/Craft 8 Exercise/Walking 8 Community Access 7 Anxiety management 6 ADL/Independent Living Skills 5 Interest/Leisure Exploration 5 Vocational Intervention 5 Gardening 4 Functional Assessment 4 Social/Socialisation 4 Cognitive Screening/Cognitive Skills 4 The above responses highlight the range and breadth of interventions used by occupational therapists in acute mental health in Ireland. It reflects good practice in the use of occupation for both assessment and intervention (Sims, 2014). The range of different activities used for therapeutic intervention reflects the NICE guidelines which advocate for a range and choice of physical, social and task groups in an inpatient setting (NICE, 2011). It also contradicts the contention of the British Association of Occupational Therapists (2006) who stated in their strategy document, Recovering Ordinary Lives, that occupational therapists lack the confidence to use activity as a therapeutic medium. The use of creative activities, physical exercise, community access and activities of daily living (ADL)/cooking tasks are among the best researched occupations used in mental health and a number of studies have highlighted their therapeutic benefits (Lim, Morris, Craik 2007, Di bona 2004, Reynolds 2003, Parkinson 2014). Vocational/leisure exploration and functional assessments featured in smaller numbers in this survey and may reflect that a significant amount of an occupational therapist s time in this survey is spent preparing and facilitating groups. Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 13

15 HSE national occupational therapy manager guidelines for occupational therapists working in acute adult inpatient approved centres Staffing and supervision n Occupational therapy in acute inpatient approved centres should be one component of a wider occupational therapy service involving occupational therapists on all the community mental health teams. n There should be a minimum of one senior occupational therapist and one staff grade occupational therapist for an approved centre to minimise lone working, reduce burnout and ensure a quality service for users and families. n Senior occupational therapists should receive occupational therapy supervision monthly and staff grade occupational therapists fortnightly in accordance with the Association of Occupational Therapists of Ireland (AOTI) supervision policy (2010). n Occupational therapy assistants should have onsite professional clinical supervision from an occupational therapist. n Occupational therapy assistants should have a clear job description, work under the direction of an occupational therapist and work within their field of competency. n Best practice indicates that if there is no occupational therapist present in the approved centre individual occupational therapy needs identified in the multidisciplinary care plan should be addressed by occupational therapists on the community mental health teams. n Training and CPD needs of occupational therapy staff working in approved centres should be identified and addressed by the staff member in unison with their supervisor and occupational therapy manager. Referrals and care pathways n The occupational therapy service should have a written outline of the occupational therapy role and referral pathway. n A model of occupational therapy practice should guide the occupational therapy care pathway for service users. n A documented referral pathway and initial occupational therapy screening assessment is recommended. n Occupational therapy interventions should respond to individuals needs and be documented in the client s care plan in accordance with Regulation 15: Individual Care Plan (Mental Health Act, 2001). 14 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

16 Multidisciplinary working n Occupational therapists in approved centres should collaborate with the multidisciplinary team in care planning and in contributing to the development of the therapeutic programme in accordance with Regulation 15 and 16 of the Mental Health Act, n Where service users have physical needs appropriate to occupational therapy, the occupational therapist should work in collaboration with the occupational therapist in primary care/general hospital as appropriate. Occupational therapy assessment and intervention n Occupational therapy standardised assessments and outcome measure should be used where possible. n Following assessment, an occupational therapy intervention plan should be devised in collaboration with the service user and the multidisciplinary team. This may include, plans for further assessment, individual work, therapeutic group work, and discharge planning. n Individual work may include independent living skills, vocational exploration, community inclusion and leisure exploration. n Occupational therapy groups should be evidence based and have clear protocols. n Group size should reflect the space available and purpose of the group. n Written information should be available for service users and carers about occupational therapy groups. n Therapeutic use of occupation is a core feature of occupational therapy interventions. n Service users should be consulted in the planning and evaluation of occupational therapy service delivery. It is recommended that external advocacy groups are involved in this process. Discharge Planning n There should be a written protocol to ensure a smooth care pathway between inpatient and community occupational therapists. n Where a client is referred to another service, e.g., a vocational service, arrangements should be made to ensure follow-up and support. Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 15

17 References AOTI (2010) Professional Supervision in Occupational Therapy. Accessed from December 2015 Binnema, D. (2004) Interrelations of psychiatric patient experiences of boredom and mental health. Issues Mental Health Nursing 25 (8) Boardman, J., Parsonage, M. (2005) Defining a Good Mental Health Service. A Discussion Paper. Sainsbury Centre for Mental Health. Bowers, L., Simpson, A., Alexander J., et al. (2005) The Nature and purpose of acute psychiatric wards: The Tompkins Acute Ward Study. Journal of Mental Health 18 (4): Cole, M.B. (2008) Group dynamics in occupational therapy.4 th ed. Slack Inc. New York College of Occupational Therapists. (2006) Recovering Ordinary Lives. The strategy for occupational therapy in mental health services Literature Review. London. COT Department of Health 2006, A Vision for Change, Report on the Expert Group on Mental Health Policy Duffy, R., Nolan, P.(2005) A survey of the work of occupational therapists in inpatient mental health services: Mental Health Practice 8.6 (2005): Faedo, G., Normand, C. (2013) Amnesty International Ireland and Mental Health Reform. Summary and Commentary on the TCD report: Implementation of A vision for change for Mental Health Services Galper, D., Trivedi, M.H., Barlow,C.E., Dunn, A.L., and Kampert, J.B. (2006) Inverse association between physical inactivity and mental health in men and women. Medicine and Science in Sports and Exercise, 38(1)pp Garcia, I., Kennett, C., Quraishi, M., Durcan, G. (2005) AcuteCare 2004: A national survey of adult psychiatric wards in England. The Sainsbury Centre for Mental Health, London Garnham, M., Morley, M., Forsyth, K., Lee, S.W, Taylor, R., Kielhofner, G. (2010) Occupational Therapy care packages in mental health. Preparing for payments by results. Gutman, S.A., Greenfield, R. (2014) Centennial Vision Five years of mental health research in the American Journal of Occupational Therapy, American Journal of Occupational Therapy, 68, p21-36 HRB 2013, Activities of Irish Psychiatric Units and Hospitals. HRB Dublin Lloyd, C. Williams, P.L (2010) Occupational therapy in the modern adult acute mental health setting: a review of current practice. International Journal of Therapy and Rehabilitation. Vol 17(9) Lal, S. (2010)Commentaries. International Journal of Therapy and Rehabilitation. Vol 17 (9) Lim, K.H., Morris, J., Craik, C. (2007) Inpatient perspectives of occupational therapy in acute mental health. Australian Journal of Occupational Therapy Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

18 Melton, J., Forsyth, K., Metherall, A. (2008). Program redesign based on the Model of Human Occupation: Inpatient services for people experiencing acute mental illness in the UK. Occupational Therapy in Health Care 22:37-50 Mental Health Commission (2011) Your views of mental health inpatient services. Inpatient survey Executive Summary Report. Dublin. Mental Health Commission MHC (2015) Judgement Support Framework. Dublin Mental Health Commission NICE (2011) Quality standard for service users experience in adult mental health. Accessed from January 2015 Parkinson, S. (2014) Recovery through Activity. Speechmark, London. Simpson, A. (2010) Commentaries. International Journal of Therapy and Rehabilitation. Vol 17 (9) Sims, K.L. (2014) The Acute Setting. In Creeks Occupational Therapy and Mental Health, 5 th ed. Church hill Livingstone, Edinburgh. Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 17

19 APPENDIX 1: Survey of occupational therapy services within adult acute inpatient approved centres Name and location of approved acute inpatient centre Number of beds Which model of consultant psychiatry? Inpatient psychiatrist or sector team psychiatrists Occupational therapy staffing within inpatient unit. Number of occupational therapy staff, WTE and grade. Number of occupational therapy assistants and WTE. Other health and social care professionals employed within approved centre and WTE. In reach from community mental health Yes No Comment occupational therapists? Referral procedure to occupational therapy for individual work? e.g., blanket, written, verbal. Referral procedure to occupational therapy for group work? e.g., blanket, written, verbal Are occupational therapy initial assessments carried out prior to clients attending group/therapeutic programme? 18 Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres

20 Average no. of groups facilitated by occupational therapy staff per week including occupational therapy assistants Of these how many are open groups? Number of groups co-facilitated with occupational therapist and other profession (name profession) Other nursing staff contributing to therapeutic programme, e.g., activity nurses. Other allied health professionals contributing to therapeutic programme from community mental health teams Sessional staff contributing to therapeutic programme, e.g., art teachers, etc. Service users/advocates/carers contributing to therapeutic programme Does inpatient occupational therapists attend care planning meetings? Number of MDT meetings per week in unit and number attended by inpatient occupational therapists? Documentation. Continuous MDT progress notes or separate occupational therapy notes? List of occupational therapy therapeutic activities/interventions and programmes Good practice initiatives that you want to highlight Other comments Guidelines for Occupational Therapy Services within Adult Inpatient Acute Mental Health Approved Centres 19

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